title: Airway pressure release ventilation: a neonatal case series and review of current practice.
abstract: BACKGROUND
  The use of airway pressure release ventilation (APRV) in very low birth weight infants is limited.
  
  
  OBJECTIVE
  To report the authors' institutional experience and to review the current literature regarding the use of APRV in pediatric populations.
  
  
  METHODS
  Neonates <1500 g ventilated using APRV from 2005 to 2006 at McMaster Children's Hospital (Hamilton, Ontario) were retrospectively reviewed. Publications describing APRV in children from 1987 to 2011 were reviewed.
  
  
  RESULTS
  Five infants, 24 to 28 weeks' gestational age, were ventilated using APRV. Indications for APRV were refractory hypoxemia (n=3), ventilatory dyssynchrony (n=1) and minimizing sedatives (n=1). All infants appeared to tolerate APRV well with no recorded adverse events. Current pediatric evidence regarding APRV is primarily observational. Published experience reveals that APRV settings in pediatrics often approximate those used in adults, thus deviating from the original guidelines recommended in children. Clinical outcomes, such as oxygenation, ventilation and sedation requirements, are inconsistent.
  
  
  CONCLUSIONS
  APRV is primarily used as a rescue ventilation mode in children. Neonatal evidence is limited; however, the present study indicates that APRV is feasible in very low birth weight infants. There are unique considerations when applying this mode in small infants. Further research is necessary to confirm whether APRV is a safe and effective ventilation strategy in this population.
authors.forename: Shikha
authors.initials: S
authors.lastname: Gupta
authors.forename: Vinay
authors.initials: V
authors.lastname: Joshi
authors.forename: Preetha
authors.initials: P
authors.lastname: Joshi
authors.forename: Shelley
authors.initials: S
authors.lastname: Monkman
authors.forename: Kelly
authors.initials: K
authors.lastname: Vaillancourt
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
mesh_terms: D045422:Continuous Positive Airway Pressure; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies